Download final lesson plan intake and output huggler - NJDOE Math-in-CTE

Math-in-CTE Lesson Plan Template
Lesson Title: Monitoring Fluids in the patient,,
Lesson # 4
Author(s):
Carol Huggler
E-mail Address(es):
[email protected]
Phone Number(s):
908-309-9480
Lucille P. Jarosinski
732-232-1853
[email protected]
Occupational Area: Nursing
CTE Concept(s): Observation and Assessment / Intake and Output
Math Concepts: Adding, Subtracting, Multiplying, Dividing, Percents, Decimals, Conversions, Volume Measurements
Lesson Objective:
SWBAT measure and record intake and output.
Supplies Needed:
Common household fluid measurement receptacles (measuring cups, measuring spoons, soup bowls, coffee cup
cups, water and juice glasses), urinals, graduates, specimen hat, water pitcher, medicine cups), pencils, paper,
worksheets
THE "7 ELEMENTS"
TEACHER NOTES
(and answer key)
1. Introduce the CTE lesson.
Students had previous recent lessons on conversions between household
and metric conversions and the urinary system. Review vocabulary words
Today we’re going to talk about monitoring fluids in the
related to lesson (voiding, fluid overload, dehydration, homeostasis, fluid
patient.
balance, and emesis).
Ask: How many of you have ever been dehydrated? How
did you feel? How did you get dehydrated?
The students will probably tell you about the times they were dehydrated,
Ask: Why is it important for the doctors and nurses to know
how they felt (weak, flushed, dry mouth and mucus membranes,
your hydration status (whether you’re dehydrated, wellnauseated), and what caused it (stomach virus, medications such as
hydrated, or in fluid overload?
antihistamines, excessive exercise in the heat).
The students will probably explain that a pt. could get very sick or die if
they get dehydrated (especially infants, children, and the elderly). Teacher
might have to explain that fluid overload can be just as serious (Congestive
heart failure)
Ask: What kind of fluids did you drink today?
The students will probably tell you they drank coffee, energy drinks, soda,
water, milk, etc.
Students will probably give examples such as sherbert, ice cream, jello,
What about fluids that appear to be solid when cold or
etc.
frozen, but turn liquid at room temperature?
The students will probably say IV fluid or blood transfusions. You can add
Ask: What other ways do patients take in fluids besides
tube or enteral feedings for pts who cannot eat by mouth. Show pictures of
drinking them?
NG tubes, gastrostomy tubes, and feeding pumps from Diversified Health
Occupations 7th edition, p. 850). You can also discuss fluid irrigation of
tubes such as foley catheters or G-tubes.
Ask: Now that you know what fluid intake is, what do you
think fluid output is in the patient?
The fluids you just listed are known as fluid intake. This is the amount of
liquid you ingest. Nurses and doctors need to measure this fluid
sometimes to monitor pt’s hydration status.
What body fluids would be considered output? What is
Students will probably say urine and vomit or emesis. You might have to
insensible loss?
add, what about liquid stools, fluid from drainage or irrigation of tubes? Ask
if the student has ever breathed on a window and wrote their name. Tell
How do doctors and nurses measure the fluids? What units them that breathing and perspiring adds up to 800 mL daily.
of measurement would they use?
2. Assess students’ math awareness as it relates to the CTE
lesson.
Students might say the fluids are measured in cups, ounces, pints, etc.
You might have to add metric units are common in the health care settings.
This is to review recent previous lesson on conversions from householdBring out examples of receptacles used in measuring intake and metric.
output (household and metric).
Ask: What are the differences between the measuring devices?
Students might say the measuring devices hold different amounts such as
cups, ounces, liters, mls (cc), etc.
Stress health care uses metric system, but pts. May refer to liquids in
Holding up the various measuring devices (cups, spoons), ask:
household units.
how much fluid each holds.
Ask:
1. What is one ml equivalent to?
This assessment of conversions could be in form of written quiz or verbal—
see attached sheet:
2. How many mls in a teaspoon?
1. 1 cc (stress this is important and sometimes
interchangeably—mls are preferred in health field).
3. How many teaspoons in a tablespoon?
2. 5 mL
4. How many mls in a tablespoon?
3. 3 t.
5. How many tablespoons in an ounce?
4. 15 mL
6. How many mls in an ounce?
5. 2 T.
7. How many ounces in a cup?
6. 30 mls (stress—very important to remember!)
8. How many mls in a cup?
7. 8 ounces
9. How many cups are there in a pint?
8. 240 mls
10. How many ounces in a pint?
9. 2 cups
11. How many mls are there in a pint?
10. 16 ounces
12. How many cups in a quart?
11. 480 mls (sometimes rounded off to 500 mls)
13. How many ounces are there in a quart?
12. 4 cups
14. How many pints are there in a quart?
13. 32 ounces
15. How many mls are there in a liter?
14. 2 pints
16. How many mls are there in a half liter?
15. 1000 mls
17. How many mls are there in a 2 liter bottle of soda?
16. 500 mls
17. 2000 mls
used
3. Work through the math example embedded in the CTE Can be done verbally or see attached worksheet to copy for students.
lesson.
Students might say you could estimate the amount taken in (fluid intake).
Let’s say your pt. Mr. Melvin Liquidator had a half pint of milk on You would stress that if the pt. is on strict intake & output (I & O), you
his breakfast tray@ 8 am (0800 military time) and did not drink all would have to accurately measure the amounts taken in and put out.
of it… How would you determine the amount of fluid he drank in
You would have a graduate for measuring and pour remaining half pint of
mls (the preferred fluid units used in health care)?
milk in it to measure. Then subtract this amount from the original amount
in the container. Be sure the amounts are in mls.
Ask: using this graduate, how could you determine accurately the You would actually use a milk carton (previously emptied, rinsed with hot
fluid intake for this liquid?
water, and refilled with tap water). When you poured out the remaining
liquid, have a student come up and tell you how much is in the graduate.
The amount would be 60 mls or ccs.
Ask: How many mls are there in a pint? How many mls in a half
There are 480 mls or 2 cups in a pint. There are 240 mls in a half pint.
pint?
Student (s) will all try to do calculation at their desks. One student will put
Using their own scrap paper, who can calculate the amount of
it on the board after checking with teacher to see if answer is correct.
fluid intake for this pt. for this liquid?
240 mls – 60 mls (amount remaining in carton) = 180 mls
Ask: What is the fluid intake for this pt. for this liquid?
180 mls
Let’s do some other examples:
Student (s) will explain how to measure remaining soda from can in
graduate. Then, subtract that amount in mls from the original amount of
Your pt. Mr. Liquidator drank some of his 12 ounce can of soda soda in can.
with his lunch at 1 pm (1300 military time). He is on strict I &O.
Remember, how many mls are there in an ounce? 30 mls
Someone, tell me what would you do?
OK, then, if you have 12 ounces (put on board), how many mls do you
Ask: How many mls are there in a 12 ounce can of soda?
have in the full soda can?
Students should say 360 mls.
Ask: How did you calculate that?
Student to put on board: 30 ounces X 12 = 360
Ask: Now explain how much fluid intake did the pt. have from this Student will explain how to take remaining fluid in can of soda, measure it
can of soda?
in graduate, and subtract that number from original amount in can (360
mls).
Ask: Class, now you calculate what the pt’s intake was for the
soda.
Student will pour out liquid remaining (120 mls)—teacher will measure out
ahead of time...
Students will say the pt’s intake was 240 mls. Ask student to put on the
board. 360 mls (amount in full can of soda) – 120 mls (amount remaining
Next, now that we’ve done fluid intake measurements, let’s do in can) = 240 mls (fluid intake)
output. This is easier as there are no calculations to do, just
measurement of the fluid the pt. puts out.
Confirm the amount of fluid in the graduate or urinal.
Mr. Melvin Liquidator voided (urinated) at 2 pm (1400 military
time).
Students must be able to differentiate liquid intake from solid intake.
Remind students that jello, pudding, liquidy cereals, and ice cream are all
liquid intake.
Ask: Look at this graduate or urinal and tell me how much did he
void?
Bring out a graduate or urinal and fill it to 350 mls with colored
water (preferably yellow).
Ask: How many mls are in the container?
Stress students should read graduate or urinal at eye level.
Ask: What did you just measure?
Students should state 350 mls. You confirm.
Now, that you know how to measure me & O, it’s time to chart. Students should answer output—specifically urine
Remember in nursing and health care, if it’s not charted, it’s not
done!
Watch me record the I & O on the I & O sheet. These sheets are very
important to doctors and nurses who need to carefully monitor their pts’
hydration status. I will record time and amounts of I & O in proper spaces
on chart. I will then circle the total amounts for the shift and then at the end
of the day for the 24 hour period. Use the I & O record from this PDF file—
copy and make transparency. Hand out forms for students to record same.
http://www.texashste.com/documents/curriculum/intake_and_output_08.pdf
4. Work through related, contextual math-in-CTE examples.
Now that they have an I & O record started on Mr. Liquidator, ask them to
put their names at the top and today’s date—be sure to include the year as
Let’s record this patient’s I & O on his chart.
this is also important in health care documentation!. Tell them for this
Now on the same I & O record, have students practice charting practice sheet, they should use pencil in case they make mistakes. Stress
Mr. Liquidator’s I & O for the rest of the day. Be sure to have that on a real I & O sheet, only black pen is used. They can record the I &
them total under each column and then circle the column’s total O for Mr. Liquidator as you have. 180 mls of milk intake at 8 am and 240
for the 8 hr. shift and then for the 24 hours.
mls of soda intake at 1 pm, and 350 mls of urine output at 2 pm. Total for
day shift intake = 420 mls, total output for day shift = 350 mls. Check for
accuracy.
5. Work through traditional math examples.
See attached worksheet—working thru addition, subtraction, percentages
will help do I & O. Alternate assignment: Have students create a
spreadsheet of their own budget.
6. Students demonstrate their understanding.
Discussion of how GI upset can alter homeostasis in body so that the pt.
could easily become dehydrated. Stress they would have to consult with
the pt’s doctor to start IV fluids or give medicines to stop emesis and
diarrhea.
Discussion of case study, Mr. liquidator;
Ask: Was the pt. in fluid balance, overload, or deficit.
Ask: Why? What would you do to correct that?
7. Formal assessment.
Exam having students calculate and record intake and
output.
1.
The pt. drank ½ of water glass (180 mls when full),
how much did the pt drink?
2. Record the following intake and output on the record
sheet:
1 carton of ice cream at 12 noon
1 bowl of soup at 12 noon
1000 mls of IV fluid from 7 am- 3 pm
Voided 300 mls at 2 pm
vomited 100 mls at 7 pm
drain output of 200 mls at 11 pm
3.
Was the pt. in fluid balance, deficit, or overload?
4. What needs to be done?
NOTES: